022FOR INTERNAL USE ONLY
Received by: Christine Fulton ~ ^ i
Jessica Fulton
Date Received: ~ /~/ ~„
r,:
FOIL Ser. #: ;~{
DEPARTMENT:
ASSESSOR ~
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR 0
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~/ ~U / 1 3
.Department Head approval:
(init)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: ~ /o_o / 1~
Closed by: 2 ~-
Date: ~/ ao / ( 3
Notes:
Amount Due: ~ Pages for a total of $
Name: ~Narrx~5 `tea\oz5~a- ^ check here if you are
Address: lag ~c~9e~ ; ~~ ~ f ~ ~ e. requesting that the records
~nr~~n~a.r~s ~r\~S N.~l 1ZSgn be mailed to this address.
Agency or firm:
Telephone #: (~y 5 ) ao (n - ~~ta3 FAX #: ( ) -
Email address: ~o1ot{1~TtJ'T~.~`~ahoo.co m
SPECIFIC DESCRIPTION OF RECORD: (!
FORMAT OF RECORD (if available)
^ I request to be notified when I can come to inspect the record(s) described above
~ I request copies of the records described above and agree to pay the cost of such records in
accordance with the fee schedule on the back of this application
^ I request that the records be sent via a-mail to the address listed above
^ I request that the records be faxed to the number listed above